CAJ | 학술논문

目的随访Bernese骨盆三联截骨术治疗大龄发育性髋关节脱位(DDH)以及DDH残留畸形的短期临床效果.方法 2010年11月至2011年11月采用Bernese三联截骨治疗DDH29例(33髋).其中11例(13髋)为大龄DDH,未曾接受任何治疗,男5例,女6例,年龄7～15岁,平均11.2岁；按照Tonnis分级标准,Ⅰ级8髋、Ⅱ级2髋、Ⅲ级2髋、Ⅳ级1髋.18例(20髋)为DDH治疗后残留畸形,男3例,女15例,年龄3～16岁,平均7.3岁；11例(13髋)曾行保守治疗(石膏/支架),7例(7髋)曾行切开复位+骨盆截骨/股骨截骨术；按照Tonnis分级标准,Ⅰ级15髋、Ⅱ级5髋,其中7髋合并股骨头坏死.结果 26例(30髋)获得随访,随访时间7～20个月,平均14个月,按照McKay评分标准,髋关节功能优17髋、良9髋、中1髋、差3髋.按照Severin评分标准,X线片结果优15髋、良12髋、差3髋.臼头指数术前平均(44±21)％,术后较术前升高,为平均(85±22)％,差异有统计学意义(t=7.053,P＜0.00).结论 Bernese骨盆三联截骨术治疗大龄DDH及DDH残留畸形短期临床效果良好.
목적 수방Bernese골분삼련절골술치료대령발육성관관절탈위(DDH)이급DDH잔류기형적단기림상효과.방법 2010년11월지2011년11월채용Bernese삼련절골치료DDH29례(33관).기중11례(13관)위대령DDH,미증접수임하치료,남5례,녀6례,년령7～15세,평균11.2세；안조Tonnis분급표준,Ⅰ급8관、Ⅱ급2관、Ⅲ급2관、Ⅳ급1관.18례(20관)위DDH치료후잔류기형,남3례,녀15례,년령3～16세,평균7.3세；11례(13관)증행보수치료(석고/지가),7례(7관)증행절개복위+골분절골/고골절골술；안조Tonnis분급표준,Ⅰ급15관、Ⅱ급5관,기중7관합병고골두배사.결과 26례(30관)획득수방,수방시간7～20개월,평균14개월,안조McKay평분표준,관관절공능우17관、량9관、중1관、차3관.안조Severin평분표준,X선편결과우15관、량12관、차3관.구두지수술전평균(44±21)％,술후교술전승고,위평균(85±22)％,차이유통계학의의(t=7.053,P＜0.00).결론 Bernese골분삼련절골술치료대령DDH급DDH잔류기형단기림상효과량호.
Objective To present short term outcome of Bernese triple osteotomy of the pelvis for developmental dysplasia of the hip (DDH) in elder children and residual hip deformity after previous surgery.Methods From November 2010 to November 2011,33 hips of 29 children underwent Bernese triple osteotomy in this institute.Eleven cases (13 hips) were elder DDH without any previous treatment.The patients included 5 males and 6 females,with a mean age of 11.2 years old (range,7-15 years old).According to the Tonnis grading standard,8 hips were grade Ⅰ DDH,2 were grade Ⅱ,2 were grade Ⅲ,and 1 was grade Ⅳ.Another 20 hips of 18 patients were residual hip deformity.There were 3 males and 15 females with an average age of 7.3 years old (range,3-16 years old).Eleven children (13 hips) were treated conservatively.Seven children (7 hips) underwent open reduction with pelvic and femoral osteotomy.According to the Tonnis grading standard,15 hips were grade Ⅰ DDH,and 5 were grade Ⅱ.Seven hips were diagnosed with avascular necrosis of the femoral head during follow-up.Results Twenty-six patients (30 hips) were followed up for an average time of 14 (7-20) months.Hips' function was judged by the Mckay criteria,17 hips were excellent,9 were good,1 was fair,and 3 were poor.The alignment of joint was evaluated on X radiography according to Severin classification,15 hips were excellent,12 were fair,and 3 were poor.The preoperative ace tabular head index was 44 ± 21％,which was significantly improved to 85 ± 22％ after surgery (P＜0.05).Conclusions The short-term outcome of Bernese triple osteotomy of the pelvis is satisfactory for the treatment of DDH in elder children and residual deformity.